Section GG and Self-Care Measures: Facility Guide and FAQ

A primary goal in post-acute care is to help residents and patients achieve their highest level of functioning. To improve assessments and outcomes in activities of daily living (ADLs), the Centers for Medicare and Medicaid Services (CMS) requires use of a standardized measurement tool called Section GG.

Proper use of this tool is crucial for optimized care delivery and accurate Medicare documentation. This guide and FAQ will walk you through everything you need to know about proper implementation and use of this tool in practice.

The Shift From Section G to GG: Overview

CMS’s updated Minimum Data Set (MDS) (effective October 1, 2023) outlines federally mandated clinical assessments for post-acute residents and patients. Since then, post-acute care facilities have been required to use Section GG to report on all essential ADL measures.

Before the creation of this tool, ADL reporting was conducted using Section G, which covered a narrower range of activities. In efforts to streamline more care-oriented measures, Section G was retired, making GG items the standard for assessing mobility and self-care activities.

FAQ: Implementation and Use

For post-acute care facilities, proper reporting of ADL measures is an important way to enhance care quality and inform accurate billing procedures. Below we’ll answer some of the most frequently asked questions to guide you through proper use and application of GG items.

What Is Section GG in Medicare?

This is a standardized tool that helps post-acute health professionals assess and measure essential ADLs. At a minimum, it should be used when conducting patient assessments on both admission and discharge to allow for useful progress monitoring.

The purpose of this tool is to improve post-acute care coordination and provide a universal language for ADL-related reporting. As part of CMS’s initiative to monitor quality measures, accurate documentation of GG items is also necessary to maximize Medicare reimbursements.

Who Is This Assessment Tool Used For?

GG items should be used to assess and document ADLs for all residents and patients in post-acute care settings. This includes long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health services.

Facilities should establish clear guidelines on which staff are expected to document these measures and how often. As this tool was designed for interdisciplinary use, staff members who typically aid in ADLs will likely need to conduct charting on GG items. This includes:

• Licensed Practical Nurses (LPNs)
• Nursing Assistants
• Occupational Therapists
• Physical Therapists

What Needs to Be Documented?

The full list of GG items and their definitions can be found in the CMS OASIS-E Manual. CMS mandates ADL assessments in two specific areas — mobility and self-care. Both areas have defined activity items that help determine a patient or resident’s functional independence.

• Mobility includes movements such as rolling, sitting, standing, lying, transfers, walking, and wheelchair use.
• Self-care includes activities related to eating, oral hygiene, toilet hygiene, washing, showering, and dressing.

Facilities should include all GG items and subitems in their charting systems so that staff are able to record scores upon assessment of these activities.

It’s also important to note that these items encompass minimum reporting requirements. Facilities and providers are still encouraged to document any other ADL-related activities that help inform their care process.

How Do You Score a GG Section?

Section GG scoring is conducted on a scale of one to six, based on the amount of help a resident or patient needs to complete an activity. To facilitate scoring, CMS defines this scale as follows:

• Dependent — Helper does all the effort. Patient/resident contributes no effort to complete the activity. Or, two or more helpers are required to complete the activity.

• Substantial/Maximal Assistance — Helper does more than half the effort. Helper lifts or holds the trunk/limbs and provides more than half the effort.

• Partial/Moderate Assistance — Helper does less than half the effort. Helper lifts, holds, or supports the trunk/limbs, but provides less than half the effort.

• Supervision or Touching Assistance — Helper provides verbal cues and/or touching/ contact assistance as the patient/resident completes activity. Assistance may be provided intermittently.

• Setup or Cleanup Assistance — Helper sets up or cleans up and patient/resident completes activity. Helper assists only prior to or following the activity.

• Independent — Patient/resident safely completes the activity by themselves with no assistance from helpers.

How Are Scores Assigned In Practice?

In order to get a better idea of GG scoring, we can take a look at a real-world example below.

Activity: A nursing assistant is helping a resident in a nursing home stand up from his chair. In order to complete this task, the resident needs the nursing assistant to lift his torso up while another LPN supports his arm and steadies his walker in place.

GG item and definition: Sit to Stand — The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed (or from any sitting surface).

Scoring: For this GG item, sit to stand, the nursing assistant would score this activity as a 1 since the resident needed two or more helpers to help him stand up.

CMS also provides official Section GG training that includes a wide range of example scoring scenarios. Equip your staff with necessary skills and knowledge on GG items by encouraging completion of this training.

How Do You Score Unattempted Activities?

If a patient/resident doesn’t participate in an activity included in the list of GG items, staff should refrain from leaving charting fields blank. Instead, they should use the following codes to indicate the reason that an activity was not assessed:

• 07: Resident Refused.
• 09: Not Applicable — Resident did not perform this activity prior to current injury, exacerbation, or injury.
• 10: Not Attempted — Due to environmental limitations.
• 88: Not Attempted — Due to medical condition and safety concerns.

How Do These Measures Affect Reimbursements?

Proper coding of GG items is essential for informing Medicare billing procedures. Under CMS’s Patient Driven Payment Model, GG items are incorporated into final composite scores that help determine reimbursement rates. It’s important for facilities to ensure accurate documentation and scoring, as any omissions or inaccuracies may lead to lower payments.

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